The authors

Mareike Haase, Health Advisor Bread for the World and Hannah Eger, B.Sc. Health Communication University Bielefeld. Contact:

G2H2 members’ blogs

We invite G2H2 project members to provide news about and assessments of Geneva global health processes that deserve our attention. G2H2 members’ blogs do not represent a consolidated view of the G2H2. For texts not yet published elsewhere, an informal peer review is strongly recommended. For enquiries, get in touch with the G2H2 Secretariat.

Global action or dissatisfaction?

The deadline to achieve the SDGs is right ahead, but the current progress is far from satisfactory. Especially SDG 3, which aims to “ensure healthy lives and promote well-being for all at all ages”, cannot be reached until 2030 from today’s perspective. Business as usual will not be sufficient to bring major changes.

This issue was also recognized by the governments of Germany, Ghana and Norway. In April 2018 they demanded solutions from the WHO to accelerate the process towards SDG 3. The main focus was an improved cooperation between the various actors in the health landscape. The WHO was meant to lead the process and simultaneously reinforce the work of its core mandate, namely to coordinate global health.

Many of us strongly approved this initiative, as we have criticized for a long time the fragmentation in the health sector as well as the weak position of the WHO. 17 years ago the GFATM and Gavi were founded and since then, about 100 health initiatives were established, which mainly work parallel to each other instead of together. This leads to a loss of efficiency and possible synergies, furthermore the countries suffer from high transaction costs.

To counteract this process, the WHO assured to create a „Global Action Plan for healthy lives and well-being for all“(GAP) together with to date eleven global partners. The official launch took place in Berlin in October 2018. Not more than one year later, in September 2019, the final GAP is planned to be presented at the UN-High Level Meeting. Accordingly, right now we are in the middle of the development of the plan.

What does that actually mean?

That is a rather difficult question. The whole process is non-transparent up to now. The most recent information on the WHO website is from December 2018, further news are barely known. This is alarming, considering the fact that it is only six months left to finalize the GAP – consultations with different actors, e.g. governments and civil society representatives, should have long taken place according to the official time schedule.

This seems to be one reason why until now the GAP is missing the linkage to local challenges. While countries all over the world stress, that a lack of human resources for health are one of the main reasons why SDG 3 will not be achieved, this aspect is hardly addressed in the accelerators of the GAP, which form the center of the plan. The WHO recognized this health workers crisis as well and recommended already years ago its six pillars concept as the fundament of each health system, and one pillar was the matter of health workforce. Nevertheless, the underlying causes of the health workers gap – e.g. lack of education and employment, work-related migration and the so-called brain drain – have not been addressed in a suitable manner by the health partnerships. NGOs therefore recommended adding “Health Workforce” as an accelerator to the GAP, but this has not been taken into consideration so far.

We think it would also be wise to integrate non-profit civil society organisations into the development of the GAP from an early stage on. Many of them are actually providing health services all over the world; in fragile contexts and hard to reach areas they are often the only ones. Not to forget that civil society organizations should be obliged to the public welfare according to their mandate, which distinct them from profit-oriented actors. They can represent a useful corrective in the coordination of governments with private institutions and can ensure that solutions are made in favor of the public interest. Whoever takes a look at the signatories of the GAP will quickly notice that many of them were built of or cooperate closely with venture philanthropies as well as the pharma industry. Hence such a corrective could be reasonable. However, NGOs have offered their support from months now, but their expertise has not yet been retrieved.

Is the WHO able to fulfil its core mandate?

Some even consider the GAP as a litmus test for the capacity for action of the WHO. Just like many UN organizations, it has to deal with a massive financial crisis since many years. The core contributions of its member states have stagnated for quite a bit now and the core budget is not enough to implement the priorities of the programme. Only voluntary donations from non-governmental donors, which account for 80 per cent of the overall WHO budget today, ensure the capacity for action of the WHO. All but one GAP partners are simultaneously donors of the WHO. This puts the WHO in a classic conflict of interests. It remains doubtful, whether it can actually fulfil its mandate of being a superior, coordinating instance or rather has to manoeuvre between the different particular interests of the actors.

Make the „action“ happen!

Right now there is still the possibility to direct the GAP into the right direction. During the upcoming World Health Assembly, the GAP and its process will be at the core of debate. The WHO needs to act now and take the lead, supported by its member states. It should bring all the actors together, transparently discuss the various interests and also conflicting interests and find a common base. Only if this is happening, an acknowledged and viable action plan can be the result.

Join G2H2 members, civil society colleagues and invited guests for a discussion about the GAP on Saturday 18 May 2019, as part of the Civil society meeting ahead of the 72nd World Health Assembly!